Attorney general: Insurance switch needs commission's approval
SPRINGFIELD — Illinois Attorney General Lisa Madigan says a plan to switch health coverage for state employees and retirees from fully-funded HMO plans to self-funded Open Access Plans can’t be carried out without the approval of a legislative commission.
Madigan, who issued an opinion Wednesday to the co-chairmen of the Commission on Government Forecasting and Accountability — State Sen. Jeffrey Schoenberg and State Rep. Patricia Bellock — made it clear the commission has the responsibility to decide whether it’s in the best interest of the state and its employees for the state to assume the risk of self-funded plans.
Her opinion also made it clear, however, that the commission doesn’t have authority to approve or disapprove the health benefit provider or administrator contracts.
Officials at Health Alliance Medical Plans, which currently covers about 100,000 state members in an HMO plan, said the opinion is good news for Health Alliance members who don’t want to be forced to switch insurance plans or pay more to keep their current doctors.
Both Health Alliance and Humana, another HMO covering some state workers, filed protests after the Illinois Department of Healthcare and Family Services rejected both for the upcoming benefits year starting July 1 and proposed awarding contracts to two self-funded Open Access Plans. The agency also chose two Blue Cross and Blue Shield HMOs, but the Blue Cross doesn’t serve most areas downstate with the state HMO plans. The protests are still pending.
Health Alliance spokeswoman Jane Hayes said the state agency intends for Health Alliance and Humana HMO members to switch to self-funded Open Access Plans, in which the state would pay medical claims directly instead of paying premiums to health insurance companies that would assume the risk.
That would mean 80 percent of the state’s employee group insurance members would be switching to self-funded plans when only 45 percent of state members are in self-funded plans now, she said.
“That’s a huge, fiscal economic policy change, because that moves the risk from the insurance carriers to the state,” she said.
MoreWhy would the state want to take on the risk in the first place? Especially since the Director of CMS has already said that cost savings was not considered in the decision. Just what was considered? The state already is trying to get out of its obligations to the employee pension funds, while keeping the funds under control of the state government through board appointees by the governor. To say nothing of the constant government underfunding, unfunded mandates, and control the politicians put on the funds. Is this the future for the health insurance if the state gets control of it?
And the state, with its self-funded dental plan, has already shown that it is not capable of keeping up payments to providers. It currently takes about 6 months for dental care payments to be made, and all the while the providers nag their customers, and add interest to the cost of the service. It's really hard to believe that this payment structure is in the best interests of the taxpayers and state employees.
To me it seems like the Governor is paying the rest of downstate back for them not voting for him. As usual, Chicago and it's surrounding counties are the only people who matter in this state.
It would have been better to me if they did away with Health Alliance and the other, they should do away with all HMOs for everyone. At least then it would have been fair. All this is ahead of the Obama Health Care debackle that will come our way soon.
I expected this to happen. States will make it so difficult for people to remain on their health plans and the only health plan that will be seen as the best is Obamacare and then once everyone else has been "squeezed out" because the Feds don't have to compete with anyone, then we will have the worst health care ever.
If you are gonna take an HMO from one, they should take it from all or not at all. It's a political ploy. Gotta love Illinois!
The worst of both worlds would be to get any kind of reimbursement from the state -- I'm still waiting on a dental claim from December, for Pete's sake.The state's attempts to steal pension funds and stiff workers on their health insurance makes looking for work elsewhere extremely appealing.
I hope Quinn isn't hoping for another term, because he's managed to enrage his core constituencies on every front, and for what? Nothing good that I can see.
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